Dental crowns: procedure, time, cost in Jacksonville

DENTAL CROWN

This is a tooth shaped ‘cap’ placed over the tooth that serves to cover it in order to restore its shape, size, strength and improve its appearance.

When cemented into place, the crown will fully encase the visible part of a tooth lying at and above the gum line.

WHY IS A DENTAL CROWN NECESSARY?

It provides protection for a weak tooth, such as one that has already started to decay, from breaking apart or helps hold parts of a cracked tooth together.
To restore a severely worn out or already broken apart tooth.
It serves as an outer covering to support and protect a tooth wit
h a large filling when there isn’t much area of the tooth remaining.
To help hold a dental bridge in position.
It helps to cover a severely discolored or ill-shaped tooth.
It provides protection by covering a dental implant.
To make cosmetic modifications.

In children a dental crown maybe used over primary (baby) teeth for one of the following reasons:

To save a badly decayed tooth that is unable to be supportedby a filling.
To provide protection for the teeth at high risk of decay especially in children who don’t adhere to daily oral hygiene.
It serves as an alternative in children who cannot undergo procedures that require general anesthesia due to their age, behavior or medical history and poor compliance to proper dental
hygiene. In such instances the dentist will likely recommend a stainless steel crown.

WHAT TYPES OF CROWNS ARE AVAILABLE?

There are different types of material to choose from for a permanent crown such as stainless steel, metals (gold, silver or an alloy), all resin, all ceramic or porcelain fused to metal.

Stainless steel crowns - these crowns are fabricated for temporary use on permanent teeth to protect the tooth or filling until a permanent crown is made.
In children, a stainless steel crown is used as they don’t require frequent visits to set it in place and are cost effective compared to custom-made one and prophylactic dental procedures to protect a tooth without a crown.
Stainless steel crowns fit over a primary tooth that has been prepared for it. The crown covers the entire tooth and prevents it from decaying further. When the permanent tooth erupts from underneath the primary tooth, it comes off and the crown along with it.
Metal crowns – alloy with a high content of gold, platinum or base-metal alloys (for example, cobalt-chromium and nickel-chromium alloys) are generally used for the fabrication of metal crowns.
These types of crowns can withstand biting and chewing forces and can last for a long time in terms of wear and tear; they rarely chip off or break. However, the main drawback is the pronounced metallic appearance. Metal crowns are a better option for the molars at the back of the jaw as they are not noticeable.
Porcelain-fused-to-metal crowns – unlike metallic crowns these types can be made to match the color of your natural teeth. However, more wear and tear will occur to the adjacent teeth with this crown compared to those made out of metal or resins. The porcelain portion of this crown might chip or break off. Compared to fully-ceramic crowns the porcelain-fused-to-metal ones look the most alike to your normal teeth. But sometimes the metal beneath the porcelain can be visible as a dark line especially near the gum line and more so if your gum is receding. These crowns are a better choice for teeth at the front or back and for long bridges where the metal is needed for strength.
All-resin crowns – these are less durable and more likely to fracture than porcelain-fused-to-metal crowns therefore they are less expensive.
All-ceramic or all-porcelain crowns – provide the most identical color match to natural teeth than any other type. They are the most appropriate option for people with allergies to metals. All-ceramic crowns are suitable for the teeth at the front and sides.
Temporary vs. Permanent crowns – Temporary ones can be made in the dentist’s office and are usually made of an acrylic-based or stainless steel material.
Permanent crowns have to be made in a dental laboratory. The main purpose of a temporary crown is to be used as a temporary restoration until the permanent crown is made.

WHAT STEPS ARE INVOLVED IN PREPARING A TOOTH FOR A CROWN?

In order to prepare a tooth for a crown two visits to the dentist are required.

The first visit involves examining and preparing the tooth. The second visit is for the placement of the permanent crown.

At the first visit - examining and preparing the tooth
Your dentist may take a few x-rays in order to check the roots of the teeth and surrounding bone which will receive the crown. If there is extensive decay or if a risk of infection or injury to the tooth pulp exists then a root canal treatment has to be performed initially.
Your dentist will anesthetize (numb) the tooth and the surrounding gum. Then the tooth receiving the crown is filed down along the chewing surface to make room, the amount removed will depend on the type of crown to be used. If a large area of the tooth is absent (due to decay or damage) your dentist will use filling material to ‘build up’ the tooth in order to support the crown.
Once reshaping of the tooth is complete, your dentist will make an impression of the tooth which will be receiving the crown using a paste or putty. Impressions are also occasionally made using a digital scanner. To ensure that the crown will not affect your bite, impressions of the teeth surrounding the tooth to receive the crown will also be taken.
The scans or impressions will be forwarded to a dental lab where the manufacturing of the crown will take place. The completed crown will then be delivered to your dentist’s office within two to three weeks. If porcelain is the material used to manufacture the crown, your dentist will select the appropriate color shade in order to precisely match the crown to the adjoining teeth. On your first visit to the dentist’s office, a temporary crown will be made by your dentist in order to protect and enclose the prepared tooth until the final crown is manufactured. Composite is used to manufacture the temporary crown and is usually kept in place with the use of temporary cement.
Second Visit: Receiving the permanent dental crown.
On your second visit to the dentist’s office, he will take the temporary crown off and verify the fit and shade of the permanent one. If it’s satisfactory, a local anesthetic if necessary will be used to numb the tooth and the new crown will be cemented in place.

How should I care for my temporary crown?

A temporary crown is just until the permanent one is ready so it should be taken care of while keeping a few precautions in mind as suggested by your dentist.

Following are a few steps to adhere to while looking after your temporary crown.

Avoid food that have a sticky or chewy texture and will be able to grab or pull off the crown for example, chewing gum, caramel etc.
Avoid chewing from the sides of your mouth with the temporary crown and switch to the opposite side instead.
Hard food such as raw vegetables should be avoided as it could dislodge or break the crown.
When you floss in between your teeth keep in mind to slide the floss thread out horizontally rather than lifting it out and risk popping the temporary crown out.

What problems could develop with a dental crown?

Discomfort or sensitivity

Immediately after the procedure of cementing the permanent tooth you may feel discomfort as the anesthesia begins to wear off. If the newly crowned tooth has an underlying nerve then there will be some sensitivity to heat and cold. Your dentist will advise you to use a desensitizing toothpaste. If you experience any pain or sensitivity when biting down on to the newly crowned tooth, it usually means that the crown is placed too high on the tooth and requires a slight adjustment.

A chipped crown

Those crowns made of all-porcelain or porcelain-fused-to-metal are at risk of chipping. A small chip can be repaired easily using a composite resin while the crown is still attached to your tooth. This is a temporary fix. But if the chip is large the crown may need to be replaced altogether.

A loose crown

In certain instances the cement may wash out from under the crown causing it to become loose allowing bacteria to leak in and cause decay to the tooth. So if your crown feels loose then contact your dentist regarding further management.

The crown falls out of place

Sometimes the crown may fall off due to an improper fit, lack of adequate cement or a very small area of the tooth for the crown to fixate onto. If this occurs take steps to clean the crown and the tooth and using a dental adhesive or temporary tooth cement, available in stores, you can fix the crown yourself until you meet the dentist. He will provide you with the necessary instructions on how to look after the tooth and the crown until you can be seen for an evaluation. Your dentist will re-cement the crown into place or arrange for a new one if necessary.

Allergic reaction to the crown

Some people may be allergic to the porcelain or the alloys of metal used to make the crowns. This is however, quite rare.

Dark line next to the gum line of a crowned tooth

These are a common finding in porcelain-fused-to-metal crowns. A dark line, usually the metal of the crown showing through, is noticeable next to the gum line of the crowned tooth. The problem caused by this is a cosmetic one rather than a dental issue, in which case your dentist will opt for an all-porcelain or ceramic crown.

What are ‘onlays’ and ‘3/4 crown’

These are variations of the regular dental crowns. The difference between these and the regular crowns is the amount of coverage of the underlying tooth. The traditional ones cover the entire tooth and the onlays and ¾ ones cover to a lesser extent.

How long do dental crowns last?

They last between 5-15 years on average and depends on the amount of wear and tear of the crown, whether you follow good oral hygiene practices and your personal oral habits such as avoiding grinding or gritting of teeth, chewing on ice, biting fingernails, using teeth to open packaging etc.

Does a crowned tooth require special care?